When Potty Training Isn’t Working

It’s only natural for parents to get jealous when they hear of potty training prodigies who wet themselves for the last time at two years old. Currently, the average age for most children to master the art of independent toileting is between 3-3 ½ years old. However, what happens when your five-year-old is still insistent on wearing diapers and you find yourself wondering if they will end up at secondary school with a box of diapers?

If your four-year-old is still resisting training, remember that it will happen eventually. Yes, there are children whose severe disabilities impede independent toileting, but the vast majority of kids start reception in big boy or girl underwear.

How do parents help their late bloomers when it seems like potty training isn’t working?

Understand the Barriers

Rather than stubbornness, it could be that there are issues bigger at play: for instance anxiety, sensory processing disorder or another special need. For children suffering from anxiety, the fear may not be linked directly to the toilet, but something diet-related which therefore affects their digestive tract. A low-fibre diet for instance may lead to constipation or painful bowel movements. It only takes a handful of painful pooing episodes for trauma to build up and impede the ability to use the toilet.

Many experts believe that Freud was enormously misguided when he proposed that toilet-training problems are caused by anal retentiveness or withholding. Rather, when a child’s constipation develops into a condition of impacted bowels, he’s not trying to withhold — he’s trying not to be in excruciating pain.

Low muscle tone can also affect potty training. After all, the ability to sense when the bladder is filling up, to clench the muscles that hold urine in, and to sit on a toilet and squeeze all require abdominal strength. You could therefore encourage your child to do some sit ups or other abdominal exercises.

For children who are hypotonic, or irresponsive to sensations, you could take the diaper off completely, since the diaper reduces the feeling of wetness. A child may not respond to a slightly damp diaper, but will likely notice urine dribbling down their leg and will be more inclined to do something about it.

The issues surrounding potty training are as varied as the children themselves. For some, the sound of the flush is scary. For others, they’re afraid of falling into the toilet. So, try and work out your child’s individual fear, then you can work with it.

Take it Step by Step

Once you’ve determined the issues, break down the process into micro steps.

Though it may seem obvious, move all things toilet related into the toilet. For example, encourage children to sit while they have a bowel movement, even if they’re wearing a diaper and they sit on the toilet with the seat down.

One doctor reported having a four-and-a-half-year-old patient with horrible anxiety, low muscle tone and anal fissures from a history of painful movements. The child was able to poop in a diaper because of the familiarity of it, as well as the sensory feedback they got from having something wrapped around their waist and bottom. Plus, the compression of the faecal waste against their body provided a comforting pressure. So the doctor worked with his parents to create a step-by-step process to get past it. First, they cut a hole in the nappy so that he could sit on the toilet while pooping in the nappy yet still have the bowel movement fall into the toilet. He needed the pressure of the nappy around his waist. Eventually he transitioned out of a nappy, but still wore a belt around his waist for the sensory feedback.

Rethink the Reward System

We’ve all heard about the marvels of sticker charts or the power of M&Ms. However, for children whose unique circumstances pose a greater challenge to potty training, a reward system may actually be counter-productive. It’s one thing to give stickers every time a child brushes their teeth; there’s nothing painful or scary about it. It’s another thing however to ask them to walk over hot coals for an M&M, and that is what using the toilet may feel like to a child with anxiety or autism. The reward just becomes yet another thing that the child is failing to achieve.

That’s not to say encouragement is a bad thing, especially if the reward is intrinsic to the process. A few examples are:

“Way to Go” cards for children to look at while sitting in the bathroom. These could have smiley faces, or a few simple words like “You can do it!”

Special underwear as an incentive for getting out of diapers.

The chance to swim in a big children’s pool.

If you’re offering the child a glimmer of hope, you don’t need additional reinforcements, since it’s intrinsically motivating for the child to know how to use the toilet. As bad as parents may feel about their child’s resistance, remember the children often feel worse. If anything marks you as a baby, it’s the nappy — to a four year old, being called a ‘baby’ is about the worst insult you can imagine.

Back Away From the Fight

Parents with children late to toilet train are often at their wits end and patience may be hard to come by. It is important, though, to remember that potty training, like anything else, is a process. If one parent has been more entrenched in the process, back away and let the other parent take the lead it is getting exhausting. Similarly, you could enlist the help of a babysitter, anyone who can help lessen the fight with the child.

A developmental milestone happens at around age two. Along with speech and long-term memory, children develop what is known as symbolic thinking. Which means that using the toilet has become much more than a simple motor process; it is layered with emotion. The less emotion parents can add to the process, the better.

Not Until the Paperwork is Done

Don’t stop short of finishing the process. It’s not enough that a child may be out of diapers if their parents are still wiping them at 9 years old. If they can’t use a public toilet or have a sleepover because they can’t stay dry through the night, the job is not done. Toilet training is complete when they have achieved independence with all aspects of toileting.

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